Exam 1: Chapter 55 Flashcards
Lower UTIs include
Bacterial Cystitis
Bacterial Prostatitis
Bacterial Urethritis
Upper UTIs are less common and include
Acute or Chronic Pyelonephritis, Interstitial Nephritis and Kidney Abscesses.
Uncomplicated Lower or Upper UTIs
Community-acquired infection; common in young women and not really recurrent
Complicated Lower and Upper UTIs
Often acquired in hospital and related to catheterization.
For infection to occur in the Lower urinary Tract
Bacteria must gain access to the bladder, attach to and oclonize the epithelium of the urinary tract to avoid being washed out with voiding, evade host defense mechanisms and initiate inflammation
What is in the bladder to protect against bacteria?
Glycosaminoglycan (GAG) a protein that noramlly exerts a nonadherant protective effect against various bacteria
Urethrovesical Reflux
An obstruction of free-flowing urinen which is the backflow of urine from the urethra into the bladder
Ureterovesical or Vesicoureteral Reflux
Refers to the backward flow of urine form the bladder into one or both uterers.
Bacteriuria
The term used to describe the presence of bacteria in the urine
What three ways can bacteria enter the urinary tract?
Transurethral Route (Ascending Infection) BLoodstream (Hematogenous Spread) Means of a fistula from teh intestine
Most common route for infection?
TRansurethral
How big of a colony count is needed to indicate an infection?
Colony count greater than 100,000 CFU/mL
What can be seen on a microscopic level to indicate infection?
Hematuria (WBCS in the urine) and Pyuria with kidney stones
Other studies to test for UTi?
Multiple-Test Dipstick, Leukocyte Esterase TEst and Nitrite TEsting.
Testing for Sexually TRansmitted Disease
XRay
CT Scan
Ultrasonography
Intake of what can help prevent and control symtpoms of UTI?
Cranberry juice
What is Pyelonephritis?
A bacterial infection of the renal plvis, tubules, and interstitial tissue of one or both kidneys.
What can acute Pyelonephritis lead to?
Enlargement of the kdineys with interstitial infiltrations of inflammatory cells
What can chronic Pyelonephritis lead to?
Kidneys can become scarred, contracted, and nonfunctioning
Clinical Manifestations for someone with Acute Pyelonephritis
Chills, Fevers, Leukocytosis, BActeriuria, Pyuria/
Low Back pain, flank pain, n/v, malaise, painful urination
What tests can be performed for Upper UTI
Untrasound Study or Ct Scan. Radionuclide Imaging with Gallium Citrate and Indium labeled WBCs may be useful to identify sites of infection that may not be visualized on CT scan.
Urine Culture Teest and Sensitivity
What is prescribed to outpatietns for Upper UTI
A 2 week course of antibiotic agents is recommended because renal parenchymal disease is more difficult to eradicate than mucosal bladder infections
Signs of Chronic Pyelonephritis
Fatigue, HEadache, Poor Appetite, Polyuri, Excessive Thirst, And Weight Loss.
Chronic Pyelonephritis Complications
End-Stage Kidney Disease, Hypertension, and Formation of Kidney Stones
Signs and Symptoms of Uncomplicated Lower UTI
Burning on urination, urinary frequency, urgency, nocturia, incontinence and puprapubic or pelvin pain. Hematuria or back pain also present
Manifestations of Compliacted Lower UTI
Asymptomatic bacterium to gram negative sepsis with shock
Results of what tests help confirm the diagnosis of UTI?
Bacteril colony counts, cellular studies, and urine cultures
Urine cultures useful for documenting
UTI and identifying the specific organism present
Microscopic hematuria is present in how many people with actue UTI?
half
Pyuria can be seen in
UTI cases
Kidney Stones
Interstirial Nephritis
Renal Tuberculosis
Lower UTIs: Multiple-Test dipstick often includes testing for
WBCs, known as leukocyte esterase test and nitrate testing
Lower UTIs: Useful dagnostic tools?
X Ray Images
CT
Ultrasonography
Kidney Scans
Lower UTIs: CT scan may detect
pyeloephritis or abscesses
Lower UTIs: Ultrasonography and kidney scans are
extemely senstivie for detecting obstruction, abscesses, tumors, and cysts
Manaement of UTIs typically involves
pharmacologic therapy and patient education
Lower UTIs: Ideal medication for treatment of uti is
an antibacterial agent that eradicates bacteria from the urinary tract with minimal effects on fecal and vaginal flora
Lower UTIs: Acute short term treatment regimen typically lasts
3-7 days
Upper UTI: Pyeloephritis cause involves either
the upward spread of bacteria from the bladder or spread from systemic sources reaching the kidney via the blood stream
Upper UTI: Ultrasound study or CT scan may be perform to locate
obstruction in the urinary tract
Upper UTI: IV Pyelogram maybe indicated with pyelonephritis if
functional and structural renal abnormalities are suspected
Upper UTI: Radionuclide imagine with gallium citrate and indium-111 labeled wbcs may be useful to identify
sites of infection that may not be visualized on CT scan or ultrasound
Upper UTI: Urine culture and sensitivity tests are performed to determine
the causative organism so that appropriate antimicrobial agents can be prescribed
Upper UTI: Patients with acute uncomplicated pyelonephritis are most often treated on outpatient basis if they are not exhibiting
acute symptoms of sepsis, dehydration , nausea or vomiting
Upper UTI: Following acute pyelonephritis treatment, patient may develop chronic or recurring
syptomless infection persisting for months or years .
may need therapy 6 weeks if relapse occurs
Upper UTI: What is obtained two weeks after completion of antibiotic therapy or acute pyelonephritis?
Urine culture, to document clearing of infection
Upper UTI: What is essential for all patietns with UTIs?
Hydration with oral or PN fluids. Hydration helps facilitate “Flushing” of the urinary tract and reduces pain and discomofrt
Upper UTI: Extent of Chronic Pyelonephritis assessed by
IV urogram and measurements of creatinine clearance, blood urea nitrogen, and creatinine levels.
Upper UTI: What therapy will be used for Chronic Pyelonephritis?
Prophylactic antimicrobial therapy may help limit recurrence of infections and kidney scarring
Upper UTI: Impaired kidney function alters
excretion of antimicrobial agents adn necessitates careful monitoring of kidney function
Upper UTI: Nursing Management for Chronic Pyelonephritis: How much fluid is encouraged?
3-4 L.
Dilutes the urine, decrease burning on urination, and prevent dehydration
What is Stress Incontinence?
Involuntary loss of urine through an intact urethra as result of sneezing, coughing, or changing position
Stress Incontinence predominately affects who
women who have had vaginal deliveries and is throught to be result of decreasing ligament and pelvic floor support
What is Urge Incontinence?
Involuntary loss of urine associated with a strong urge to void that cannot be suppressed
Precipitaitng Factor of URge Incontinence?
Uninhibited detrusor contraction
What is Functional Incontinence?
Instances in which lower urinary tract function is intact but other factors, such as severe cognitive impairement, make it difficult for the patient to identify the need to void or physical impairments make it difficult to reach toilet in time
What is Iatrogenic Incontinence?
Involuntary lsos of urine due to extrinsic medical factors, prodominately medications
What is Mixed Urinary Incontinence?
Encompases several types of urinary incontinence, is involuntary leaking associated with urgency and also with exertion, effort, sneezing, or coughing
What can proboke the onset of urinary incontinence?
Acute UTI, infection, constipation, decreased fluid intake, and change in chronic disease pattern
Medical management types for incontinence?
Behavioral Therapy
Pharmacologic Therapy
Surgical Management
Incontinence: What is the cornerstone of behavioral intervention for addressing symptoms of stress, urge and mixed incontinece?
Pelvic floor muscle exercises (Kegel exercises)
Chronic urine retnetion leads to
overflow incontinence (involuntary urine loss associated with overdistention of the bladder)
Urinary retention may result from
diabetes, prostatic enlargement, urethral pathology, trauma, pregnancy, or neurologic disorders
The retention of urine can lead to
chronic infection that predispose patient to renal calculi , pyelonephritis, sepsis or hydronephrosis
Additional measures to promote urinary elimination include
applying warmth to relax the sphincter, giving the patient hot caffeine free beverage, and offer encouragement
Urinary Retention: When the patient cannot void, what technique is performed?
Bladder scanning is used to assess for distension then straight catheterization is used to prevent overdistention of the bladder
Urinary Retention: In the case of prostatic obstruction, what will be done
insertion of suprapubic cather (catheter inserted through a small abdominal incision into the bladder)
Urinary REtention caused by
adults 60 years and older may have 50-100 mL of urine left in bladder
Postoperative spasms
Diabetes, prostatic enlargement, urethral pathology, truma, pregnancy
Medications
Neurogenic Bladder: This is a
dysfunction frfom a disorder or dysfunction of the nervous system that leadss to urinary incontinence
Neurogenic Bladder: caused by
spinal cord injury, spinal tumor, herniated vertebral disc, multiple sclerosis, congential disorders, infections, or complications of disabetes
Neurogenic Bladder: Two types of neurogenic bladder?
Spastic (reflex) and flaccid bladder
Neurogenic Bladder: What is the more common type?
Splastic bladder, and caused by any spinal cord lesion above the voiding reflex arc
Neurogenic Bladder: Spastic bladder empties on
reflex,with minimal or no controlling influence to regulate its activity
Neurogenic Bladder: Flaccid bladder caused by
a lower motor neuron lesion, commonly resulting from trauma
Neurogenic Bladder: Flaccid bladder being recognized in patients with
diabetes
Neurogenic Bladder: Wha thappens in Flaccid Bladder?
Bladder continues to fill and become sgreatly distended and overflow incontinence occcurs.
Muscle does not contract forcefully.
Neurogenic Bladder: Assessment fo rhtis?
Measurement of fluid intake, urine output, and residual volume
Urinealysis
Assessment of sensory awareness
Comprehensive urodynamic studies performed
Neurogenic Bladder: Most common complication is
infection resulting from urinary stasis and catheterization.
Others include renal calculi, impaired skin integrity, urinary incontinence or retention
Neurogenic Bladder: Specififc interventions include
continuous, intermittent, or self-catherization ; the use of an external condom catheter ; diet low in calcium ; encouragement of mobility and ambulation
Catherization: When urine cannot be eliminated naturally and must be draind artifially, what is done?
Catheters inserted into bladder, ureter, or renal pelvis
Catherization: What are the four types of catheters/
Indwelling
Suprapubic
Condom
Indwelling
Catherization - Indwelling Catheters: What catheter commonly used fter transurethral prostate surgery?
Triple-Lumen Catheter
Catherization - Indwelling Catheters: What is the triple-lumen catheter
it is a triple lumen indwelling urethal catheter attached to a closed sterile drainage system .
Catherization - Indwelling Catheters: Triple Lumen Catheter purpose of three ports?
Urinary drainage through one channel
Retention of balloon in inflated with water or air in second
Bladder continuously irrigated with sterile irrigating osolution through third
Catherization - Indwelling Catheters: Why should the bag be lower than the patietns bladder?
Does not allow urine to flow back into the bladder
Catherization - Suprapubic Catheter: These catheters allow bladder drainage by
inserting a catheter or tube into the bladder through a subprapubic incision or puncture. Catheter or drainage tube then threaded into bladder
Catherization - Suprapubic Catheter: This may be a temporary measure to fivert flow of urine form the urethra when the
urethral route is impasable, after gynecologic or other abdominal surgery when dysfunction is to occur, or pelvis factures
Catherization - Suprapubic Catheter: This may be maintained continuously for
several weeks
Catherization - Suprapubic Catheter: When patietns abaility to pee is tested, catheter is
clamped for 4 hours .
After voiding, catheter is unclamped and residual urine is measure
Catherization - Suprapubic Catheter: To avoid encrustation, patient requires
liberal amounts of fluid
Catherization - Suprapubic Catheter: Other potential problems include
formation of bladder stones, acute or chronic infections, and problems colelcting urine
Catheterization: Signs and symptoms of UTI?
Cloudly, malodorous urine, hematuria, fever, chills, anorexia, and malaise
Catheterization: When an indwelling urinary catheter is in place , what muscle does not be used?
Detrusor muscles do not actively contract the bladder wall to stimulate emptying. They then may not respond to bladder filling resulting in urine retention or urinary incontinence
